Bowel symptoms are common in MS, but they are often not raised with healthcare teams. Many people find them difficult to talk about, or assume nothing can be done. In fact, bowel symptoms are usually manageable, and several practical steps and treatments can help.

This article explains why MS affects the bowel, what can help day to day, and the signs that mean it is worth seeking help.

Key Takeaways

• Why MS can cause bowel symptoms
• The most common bowel problems in MS
• Practical steps that can help
• The warning signs that need medical attention
• Where to find help in Australia

Why MS Affects the Bowel

MS can disrupt the nerve signals between the brain, spinal cord, and bowel. These signals control the movement of the bowel and the muscles that manage continence. When they are affected, the result can be constipation, difficulty controlling the bowel, or both.

Other factors can add to this. Reduced mobility, lower fluid intake, some medications, and changes to diet can all affect bowel function. Bladder and bowel symptoms often occur together, because the nerves that control them lie close to one another.

Common Bowel Symptoms

Bowel symptoms in MS are common. A population survey found that around two thirds of people with MS reported some form of bowel dysfunction. The two most common problems are:

Constipation. Difficulty passing stools, infrequent bowel movements, or a feeling of incomplete emptying. Research has found constipation in around 40 to 50 per cent of people with MS.

Difficulty with bowel control. Sometimes called faecal incontinence, this can range from occasional urgency to loss of control. Research has found that many people with MS have experienced this at least occasionally.

These symptoms can affect confidence, work, and social life, but they often improve with the right management.

Practical Steps That Can Help

Drink enough fluid. Adequate fluid helps keep stools soft and easier to pass.

Include fibre. Vegetables, fruit, wholegrains, and legumes add fibre, which supports regular bowel movements. Increasing fibre gradually can help avoid bloating.

Keep a regular routine. Trying to use the toilet at the same time each day, often after a meal, can help the bowel settle into a pattern.

Do not delay. Responding to the urge to go, rather than putting it off, can reduce both constipation and accidents.

Stay as active as you can. Physical activity helps the bowel work.

Review medications. Some medications can cause constipation. It is worth asking your GP or pharmacist whether any of yours may be contributing.

If these steps are not enough, further treatments are available, including laxatives, suppositories, pelvic floor exercises, biofeedback, and transanal irrigation. These are guided by your healthcare team based on your symptoms.

When to Get Help

It is worth speaking with your GP, MS nurse, or a continence service if:

• Bowel symptoms are affecting your daily life, work, or confidence
• Constipation continues despite diet and routine changes
• You are experiencing loss of bowel control
• There is a sudden change in your usual bowel habits
• You notice bleeding, black stools, unexplained weight loss, or severe pain

Bleeding, a sudden change in bowel habits, unexplained weight loss, or severe abdominal pain should always be checked promptly, as these can have causes unrelated to MS.

Australia has free continence support through the National Continence Helpline (1800 33 00 66), which is staffed by continence nurses. Your GP can also refer you to a continence physiotherapist or clinic, and many services are available by telehealth for people in regional areas.

Bowel symptoms are common in MS and are usually manageable. Drinking enough fluid, eating fibre, keeping a regular toilet routine, staying active, and responding to the urge to go can all help. A range of further treatments is available when these steps are not enough.

Some symptoms, including bleeding, sudden changes, or symptoms affecting daily life, should be checked by a healthcare professional. Raising bowel symptoms early can help you find effective management.

FAQs

Are bowel symptoms a normal part of MS? They are common in MS, affecting a large proportion of people. They are not something you simply have to accept, as management can help.

Can constipation make other MS symptoms worse? Yes. A full bowel can increase muscle spasms and bladder symptoms, so managing constipation can help with other symptoms too.

Is it safe to use laxatives regularly? Some laxatives are suitable for regular use and others are not. It is best to use them with advice from your GP or pharmacist.

Should I reduce fibre if I have bowel control problems? Not necessarily. Fibre needs are individual, and a continence professional can help you find the right balance.

When should I be concerned? Bleeding, black stools, a sudden change in bowel habits, unexplained weight loss, or severe pain should be checked promptly.

References

1. Hinds, J. P., Eidelman, B. H., & Wald, A. (1990). Prevalence of bowel dysfunction in multiple sclerosis: A population survey. Gastroenterology, 98(6), 1538–1542. https://doi.org/10.1016/0016-5085(90)91087-M
2. Wiesel, P. H., Norton, C., Glickman, S., & Kamm, M. A. (2001). Pathophysiology and management of bowel dysfunction in multiple sclerosis. European Journal of Gastroenterology & Hepatology, 13(4), 441–448. https://doi.org/10.1097/00042737-200104000-00025
3. Preziosi, G., Gordon-Dixon, A., & Emmanuel, A. (2018). Neurogenic bowel dysfunction in patients with multiple sclerosis: Prevalence, impact, and management strategies. Degenerative Neurological and Neuromuscular Disease, 8, 79–90. https://doi.org/10.2147/DNND.S138835
4. Nusrat, S., Gulick, E., Levinthal, D., & Bielefeldt, K. (2012). Anorectal dysfunction in multiple sclerosis: A systematic review. ISRN Neurology, 2012, 376023. https://doi.org/10.5402/2012/376023
5. Todd, C. L., Johnson, E. E., Stewart, F., Wallace, S. A., Bryant, A., Woodward, S., & Norton, C. (2024). Conservative, physical and surgical interventions for managing faecal incontinence and constipation in adults with central neurological diseases. Cochrane Database of Systematic Reviews, 10, CD002115. https://doi.org/10.1002/14651858.CD002115.pub6
6. DasGupta, R., & Fowler, C. J. (2003). Bladder, bowel and sexual dysfunction in multiple sclerosis: Management strategies. Drugs, 63(2), 153–166. https://doi.org/10.2165/00003495-200363020-00003